Provider Demographics
NPI:1104471416
Name:THOMAS, JERMAINE DARIO OKANG (AGPCNP-BC)
Entity type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:DARIO OKANG
Last Name:THOMAS
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:801 ALBANY ST FL GROUND
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2560
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE
Practice Address - Street 2:2ND FL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-0211
Practice Address - Country:US
Practice Address - Phone:617-414-7399
Practice Address - Fax:617-414-4676
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2320575163WP2201X, 363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care